HomeMy WebLinkAboutPermit Electrical 2010-8-17
, DEPARTMENT USE ONLY
- , ~-';;.
sfrt.\c-ooO 67
Pennit no,:
Date: g:-/7 ~/O
225 Fifth Street. Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
: . .,"',:l:fOC~L::GO"ERNMENT;~PPROVA[:';:,"J*it:O"i[":,
Zoning approval verified? 0 Yes 0 No
';,:,!"';,.:(i'C~TEGORY~OF:'CONSTRUt:,[IONY':~" '.; \.'
iJI1'Zesidential I 0 Government I 0 Commercial
I\lf~~1i:I[1J.<:>I3\kSIJE,\INF<:>RilliA1:ION1;AND~l!.Ot:A1110N:.\'.2!~;,(.,s;~r~
Job site address: Lfb C; S '3 C; f-'l1
City: r!, n '(VI !/t,{ltaJJ State: ()tfZ, I ZIP:
Reference ~rt()~::1x t\c'() I Taxlffi\r~~
, . '" ' DESCRIPTION: OF Wb~.K':'~, ,.\ '''.,',{4'' ,,'.0"..
I? e:;:w I f/1J' 1I/t:tU D ItY &fZ--
I
'PRbPERTYOWIilER
Name: )In'1 t Ctf:1..1( ~ n e72-
Address: b 7 '37 U OS.e5 /? ~ C;
City: C,fJ(UlJ&h f?lA State: tJlZ .1 ZIP:~/7tf17
Phone: f _ _ . I Fax: _ _ '
E-mail: '
200 amps or less (2) '$ 00 $
This installation is being made on residential or farm property ~ 1=roT 63.
owned by me or a member of my immediate family, This ! :;19.1., . itfJ,9ffi law requires yo to $ 87.00 $
prop'erty is not intended for sale, exchange, lease, or rent. OAR fc 11.0 _-:!':~'''~ VI~"on <JlPlny
479.540(1) and 479.560(l).Nc lit, Ilftbf9e.<I!l'illW'stti;:,~o .L - -- ,- ,...., $126.00 $
Signature: ~",r ruw,260(jl1nQiH/ilI~IIQAf:ls95J!;.UO'Ijeeders section above
J:CONTRACTOR INSTALLATION ,~i .a h:grf~ltj;.1 'jflll~"aflb.~hf!d'JJJRl>Jwr panel
Business name: L-) 173 ~ .P';/7 FJ C ' n Im'!!>rF'rffifl'li!!r~FlJc i5ffl9iIfj\\9~fllf~fi'!~ service or feeder ree:
Address: (}I.D ,&O';C (/ I ~0 lifilm~Fa~hlc~&1Qr332-2344J. . /:- $ 6.00 $ /7
City: t::i- d? /:;:7f/~ State: I')tt. I ZIP: W f'Vc; b, Fee for branch circuits without purchase of a service or feeder fee:
Phont,i.{-( -(g( f!f1q b I Fax - -
E-mail:
CCB license no,: tj Q7l(x I BCD license no.:'?t? -~c::.-
'3S'S;~S
17,) JV V lc:. 0 n:-I
Signature of signing supervisor: I k: / 011!:J ~
lJ
Signing supervisor's license no.:
Print name of signing supervisor:
~~\,Q
~t&~
~
440.2584-J (9/08/COM)
f~:},;;;i,:\;t~Fj~1~'~~f;\~;;~)~Y,y;~~~I:EEft,S-~R E,[).OJjE~~~F~~~!~~~i::~~~~~~~t,~~
jNu~,~ef'i;.fj~_~p.~~ti:o;~,~ P~.r)~~_~:(\ ';;".' Qty:
'__"'Jl'''. ',',;.,-'" "r-',,',' ..i..",' ",
Residential, per unit, service included:
Cost " Total
ea. "\..'~ost
$134.00 $
$ 25.00 $
$ 32.00 $
$ 63.00 $
1,000 sq. ft, or less (4)
Each additional 500 sq. ft. or portion
thereof
Limited energy (2)
Each manufactured home or modular
dwelling service or feeder (2)
Services or feeders: installation, alter:ation, relocation
200 amps or less (2) I $ 61.00 $ 8/
201 to 400 amps (2) $ 95.00 $
40] to 600 amps (2) $156.00 $
601 to 1,000 amps (2) $205.00 $
Over 1,000 amps or volts (2) $469.00 $
Reconnect only (2) $ 63.00 $
Temporary services or feeders: installation, alteration, relocation
First branch circuit (2)
$ 55,00
$
$
Each additional branch circuit
$ 6.00
Miscellaneous fees: service or feeder'?not included
Each pump or irrigation circle (2)
Each sign or outline lighting (2)
$
$
$ 63.00
$ 63.00
Signal circuit or a limited-energy panel,
alteration, or extension (2)
Each additional inspection: (I) $56.00 $
,i~~~g@bt~!~l~r~J~Wl:~t{t';~:~'~'Re.nl CANtw':O'SE!,;Ei~!ti~~i;&;lf'(g;!,j_~;: ."~~;
$ 63.00
$
NOTICE: (A) Enter subtotal Of above fees
THIS PERMIT SHAll EXPIR \/I1'ffWit Fee $58.00)
AUTHORIZED UNDER THIS. mllili~~r':';"; barge (12 x [A])
COMMENCED OR IS ABAND[JI!JIDq;@jIpgYFee(5%0f[A])
ANY 180 DAY PERIOD:
$ ?J
$ II.lb
$ l.({,>
$IOSI'
TOTAL fees and surcharges (A through C):
- .
,',.!'
CITY OF SPRINGFIELD
225 Fifth 51
Springfield.OR 97477
541-726-3753
TRANSAGTIONHECEIPT
www.ci.springfield.or.us
permitcenter@cLspringfield , or. us
RECEIPT NO: 20\0000067
RECORD NO: 811-SPR201O-00067
DATE: 08/17/2010
State of Oregon Surcharge (12% of applicable fees)
Technology Ie:e (5% 01 E,:,!"it total)
: :~MP_Ll~I.D:LlE :
$81.00
$12.00
$11.16
$4.65
..... :' ~....,:l
'.p- - ~'/AC_C.OON'f~C.OtlE"!';':
224-00000-426102
l.. ':. ,'.' 2~4-00000-426102
,...'... .." :'0. . .821.00000-21500'4
""'~-
"'(,',': :.' :,. , . 100-00000.425605
,.',,'''-'....-,---~.,' - -"".__.,',
-,.'" TOTAL DUE: $108.81
lr"PA YMENT lYPS' . '..R4;iQR: .~;.:: CASHlSRPSOWU;BY,,'CCpMMENIS,-,--, lit.:', , L~ ..:J6.iAr:!I()J-!t.lH~ID_..1-,-~.J
Check lite electric service $108.81
tDEstRIR.tION,~':;C::::' -':':f,,*,=-.i.-0~-- - ',..."'~-...,r..
Services 200 amps or less
Branch circuits with service or feeder each circuit
7299
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